Circle Medical · 1 month ago
Medicare Enrollment Specialist
United States
Full-time
Remote
Senior Level
$22/hr - $27/hr
5+ years expCircle Medical is a venture-backed Y-Combinator healthcare startup on a mission to make high quality healthcare accessible through technology. The Medicare Enrollment Specialist is responsible for managing the full cycle of Medicare enrollment for individuals and group entities, ensuring compliance with federal regulations and maintaining data accuracy throughout the process.
FitnessHealth CareInsuranceWellness
Responsibilities
Prepare and submit complex initial, reassignment, and change of information enrollments in the PECOS system for both individuals and the organization, including sensitive ownership changes and new location additions, ensuring 100% data accuracy
Act as a trusted point of contact for providers, assisting with pending surrogacy requests, signing pending enrollments, I&A system login issues, and providing expert-level support via phone, email, or online platforms
Proactively ensure all enrollment activities strictly adhere to federal regulations, including CMS and HIPAA requirements. Participate in internal audits to maintain a high standard of compliance
Respond promptly and professionally to internal and external inquiries related to enrollment, eligibility, application status, or complex payer issues, serving as the subject matter expert
Maintain impeccably accurate and up-to-date provider enrollment data across NPPES and internal credentialing softwares, identifying and correcting discrepancies immediately
Meticulously record and track all enrollment approvals, denials, reconsiderations, and appeals within Credentialing systems, providing clear, timely, and actionable updates to Revenue Cycle, Credentialing, and Operations teams
Maintain and proactively update Standard Operating Procedures (SOPs) to reflect current processes, regulatory changes, and updated CMS guidance, contributing to team efficiency and knowledge sharing
Qualification
Required
High School Diploma or GED
Minimum of 5 years of dedicated experience in payer enrollment and/or credentialing or equivalent demonstrated competency
Minimum of 3 years of hands-on, expert experience using the PECOS system with a strong, current knowledge of CMS enrollment requirements and processes
Exceptional Attention to Detail & Accuracy: Possesses a meticulous, error-averse work ethic with an unwavering focus on data accuracy and completeness across all systems (PECOS, NPPES, internal software)
Consultative Communication: Demonstrates clear, professional, and empathetic verbal and written communication, capable of translating complex regulatory requirements into understandable guidance for providers and internal teams
Analytical Problem-Solving: Ability to analyze, troubleshoot, and resolve complex enrollment discrepancies, denials, or system issues with minimal supervision, exercising sound judgment in decision-making
Organizational Mastery & Time Management: Proven ability to prioritize and manage a high-volume pipeline of enrollment cases simultaneously, effectively meeting strict regulatory and internal deadlines in a remote environment
Accountability & Adaptability: Exhibits a high degree of self-motivation, ownership, and accountability for enrollment outcomes, and demonstrates flexibility to adapt to frequent and critical regulatory changes from CMS
Confidentiality & Discretion: Handles all provider data and Protected Health Information (PHI) with the utmost confidentiality in strict adherence to HIPAA guidelines
Preferred
Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field
Experience with a major credentialing software (e.g., Modio, Cactus, Symplr, MedTrainer)
Experience supporting enrollment for a multi-state organization
Benefits
Flexible vacation & sick leave (eligibility after 90-days)
10 paid holidays
$500 annual education and development reimbursement
Medical, Dental, Vision benefits, Life & additional supplemental coverage options
401K + Company Matching Program per eligibility
Company
Circle Medical
Circle Medical is the doctor's office that comes to you, paid for by your insurance.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
$12.51MKey Investors
A.Capital VenturesCollaborative Fund
2020-09-01Acquired
2019-03-01Equity Crowdfunding
2018-11-02Series Unknown· $3.5M
Leadership Team
JS Boulanger
Cofounder & CTO
Recent News
Fierce Healthcare
2025-05-07
Company data provided by crunchbase